【摘要】：目的 通過(guò)比較成人重度、輕中度阻塞性睡眠呼吸暫停低通氣綜合癥(Obstructive sleep apnea—hypopnea syndrome，OSAHS)患者及非OSAHS健康對(duì)照組研究對(duì)象外周血中KL-6、內(nèi)皮素（ET-1）水平，探討血管內(nèi)皮細(xì)胞損傷與單純OSAHS的相關(guān)關(guān)系及相關(guān)程度，并初步了解單純OSAHS罹患心血管并發(fā)癥的風(fēng)險(xiǎn)性以及KL-6在OSAHS心血管并發(fā)癥風(fēng)險(xiǎn)評(píng)估方面的作用。 方法 選取2011年3月至10月期間就診于湖南省人民醫(yī)院的75例打鼾成人，其中25例來(lái)自門(mén)診體檢病人，根據(jù)Epworth嗜睡量表（ESS）及Berlin睡眠質(zhì)量評(píng)估問(wèn)卷歸入非OSAHS正常對(duì)照組，另50例研究對(duì)象為該院耳鼻咽喉頭頸外科同期住院病人，根據(jù)睡眠呼吸監(jiān)測(cè)（polysomnography，PSG）結(jié)果歸入輕中度OSAHS組、重度OSAHS組，每組各25例病人，所有研究對(duì)象均無(wú)診斷明確的明顯心血管事件及內(nèi)分泌疾病、肺部疾患、腫瘤、急性期感染；均無(wú)煙酒嗜好，近期無(wú)重大外傷，無(wú)長(zhǎng)期服用血管活性藥物史。所有非OSAHS組研究對(duì)象行問(wèn)卷調(diào)查（ESS及Berlin睡眠質(zhì)量評(píng)估問(wèn)卷）或OSAHS組病人行PSG監(jiān)測(cè)后當(dāng)日清晨空腹抽取肘靜脈血，專人離心取上層血清，放入-80℃冰箱凍存，待所有標(biāo)本收集完備后專人采用酶聯(lián)免疫分析技術(shù)（ELISA）一次性批量測(cè)定各組患者治療干預(yù)前外周血清KL-6與ET-1水平。分析KL-6與ET-1水平和呼吸紊亂指數(shù)（apnea hyponea index,AHI）、夜間最低血氧飽和度(Lowest oxygensaturation,LSaO2)等疾病相關(guān)指標(biāo)的關(guān)系。運(yùn)用SPSS13.0統(tǒng)計(jì)軟件對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 ①KL-6在非OSAHS組和輕中度OSAHS組患者中血清水平差異無(wú)統(tǒng)計(jì)學(xué)意義（P=0.3610.05），重度OSAHS組患者中的血清水平明顯高于非OSAHS組和輕中度OSAHS組（P=0.0000.05）；ET-1在非OSAHS組和輕中度OSAHS組患者中血清水平差異無(wú)統(tǒng)計(jì)學(xué)意義（P=0.2930.05），重度OSAHS組患者中的血清水平明顯高于非OSAHS組和輕中度OSAHS組（P=0.0000.05）。②KL-6、ET-1血清水平與OSAHS患者AHI、LSaO2、BMI有相關(guān)性（P0.05），，與患者性別、年齡無(wú)關(guān)（P0.05）。③OSAHS患者血清中KL-6、ET-1水平呈正相關(guān)（r=0.942，P=0.0000.05）。 結(jié)論 單純重度OSAHS患者存在血管內(nèi)皮細(xì)胞損傷，與疾病嚴(yán)重程度相關(guān)，與患者性別、年齡無(wú)關(guān)。單純重度OSAHS患者并發(fā)心血管并發(fā)癥的風(fēng)險(xiǎn)性可能高于單純輕中度OSAHS患者及非OSAHS患者；KL-6對(duì)于OSAHS病程后期或重癥患者心血管并發(fā)癥的風(fēng)險(xiǎn)性可能具有較好的預(yù)測(cè)作用。
[Abstract]:Objective to compare the levels of KL-6, et (ET-1) in peripheral blood of adult patients with severe, mild to moderate obstructive sleep apnea hypopnea syndrome (Obstructive sleep apnea-hypopnea syndrome,OSAHS) and non-OSAHS healthy controls. To investigate the relationship between vascular endothelial cell injury and simple OSAHS, and to understand the risk of cardiovascular complications in OSAHS and the role of KL-6 in the risk assessment of cardiovascular complications in OSAHS. Methods 75 snoring adults from March to October 2011 in Hunan Provincial people's Hospital were selected, of which 25 were from outpatient physical examination. According to Epworth narcolepsy scale (ESS) and Berlin sleep quality assessment questionnaire, they were classified into non-OSAHS normal control group. Another 50 patients were hospitalized in otorhinolaryngology head and neck surgery at the same time. According to the results of sleep respiratory monitoring (polysomnography,PSG), they were classified into mild to moderate OSAHS group and severe OSAHS group with 25 patients in each group. There were no obvious cardiovascular events, endocrine diseases, lung diseases, tumors and acute infection in all the subjects. There was no smoking and alcohol addiction, no major trauma in the near future, and no history of taking vasoactive drugs for a long time. All the subjects in the non-OSAHS group were investigated by questionnaire (ESS and Berlin sleep quality assessment questionnaire) or the patients in the OSAHS group were monitored by PSG. The elbow vein blood was taken on an empty stomach in the morning, and the upper serum was centrifuged and frozen in the refrigerator at-80 鈩

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